MPS 10-08 Renoprotective effect of eplerenone in comparison to thiazide diuretic in hypertensive patients with chronic kidney disease

Objective: The aim of the present study was to compare the anti-albuminuric effect of addition of eplerenone and thiazide diuretic to hypertensive patients with chronic kidney disease treated with angiotensin II receptor blocker (ARB). This study is sub-analysis of OWASE (Optimal hypertension therapy With Aldosterone blocker SElara) study that we presented in the 37th annual scientific meeting of the Japanese Society of Hypertension. Design and Method: The present study was a multicenter, prospective, open-label randomized, controlled study. We enrolled hypertensive patients, who had received an ARB, with albuminuria (pre-treatment urinary albumin/creatinine [Cr] ratio [UACR] 30–300 mg/gCr), and an estimated glomerular filtration rate (eGFR) ≥36 ml/min/1.73 m2. Eligible patients were randomly assigned to either receive eplerenone (50 mg daily) or thiazide diuretic (hydrochlorothiazide 12.5 mg daily or trichlormethiazide 1 mg daily) with standard antihypertensive therapy for 48 weeks. The primary end point was the mean percent change in the UACR from baseline to 48 weeks. Results: Of the assigned patients, 68 (42 in the eplerenone group and 26 in the thiazide diuretic group) were included in the efficacy analysis. Baseline UACR was similar in the two groups (eplerenone, 121.7 mg/gCr; thiazide diuretic, 99.4 mg/gCr, P = 0.230). Baseline systolic blood pressure was significantly higher in the thiazide diuretic group than the eplerenone group (eplerenone, 143.7 mmHg; thiazide diuretic, 155.4 mmHg, P = 0.001), however, achieved systolic blood pressure was similar in the two groups at 48 weeks (eplerenone, 135.5 mmHg; thiazide diuretic, 137.6 mmHg, P = 0.609). In the primary efficacy analysis, the mean percent change in the UACR from baseline to 48 weeks was similar in the two groups (eplerenone, −31.9%; thiazide diuretic, −37.6%, P = 0.735). Conclusions: The renoprotective effect of eplerenone combined therapy was similar to thiazide diuretic when combined with ARB in hypertensive patients with CKD.